Why It Matters
Nebraska’s Medicaid program director has stepped down weeks after the state became the first in the nation to implement work requirements for the health insurance program. The departure leaves the state managing an emerging policy that could serve as a national model or cautionary tale as other states consider similar measures.
What Happened
Drew Gonshorowski, who led Nebraska’s Medicaid and Long-Term Care division since December 2024, resigned to pursue opportunities on the East Coast and be closer to family. His departure comes as the state navigates the rollout of work requirements—a centerpiece of Gov. Jim Pillen’s “One Big Beautiful Bill” package of policy changes.
Gonshorowski oversaw the implementation of the work requirement rules, which took effect in phases. New Medicaid enrollees became subject to the requirements on May 1, while existing enrollees faced the same mandate beginning August 1. State officials estimate approximately 200 Nebraskans will lose coverage as a result of the new rules.
Jeremy Brunssen, who previously served as interim director of the same division in 2020, has been appointed interim director while the state searches for a permanent replacement. Brunssen currently holds the position of deputy director of finance and program integrity within the Medicaid and Long-Term Care division and has worked at the state’s Department of Health and Human Services for nearly a decade.
Gov. Pillen credited Gonshorowski’s leadership in advancing the work requirement initiative, which he characterized as central to the broader legislative agenda.
By the Numbers
December 2024 — Gonshorowski began serving as director
May 1 — effective date for work requirements applying to new Medicaid enrollees
August 1 — effective date for work requirements applying to existing enrollees
200 — estimated number of Nebraskans projected to lose Medicaid coverage under the new requirements
8 months — length of Nebraska’s early implementation compared to the federal deadline
January 1, 2027 — federal deadline for state work requirement implementation
Zoom Out
Nebraska’s decision to implement work requirements ahead of the federal deadline positions it as the first state to test this approach at scale. The policy reflects a broader shift among Republican-led states to condition Medicaid eligibility on workforce participation. Other states have sought or are considering similar federal waivers, with the Trump administration signaling openness to state-led reforms of the program.
The work requirement debate centers on competing priorities: whether conditioning benefits encourages workforce participation or whether it removes coverage from people unable to meet employment thresholds due to age, disability, or lack of available work.
What’s Next
The state will conduct a formal search for a permanent Medicaid director while Brunssen manages the division in an interim capacity. Nebraska will also monitor coverage losses and labor force participation rates under the new rules as data emerges—information that could inform how other states approach similar waivers. The program’s first full year of operation under work requirements will unfold against the January 2027 federal deadline, when other states must begin compliance.